To explore the concept of “kao-no-mieru kankei (face-to-face relationships)” and effects on community care networks, questionnaire and interview surveys were conducted involving 207 and 5 health care professionals, respectively. The item “face-to-face relationships” were significantly correlated with “I know his/her name, face, and way of thinking” “I understand the principles and current status of the facility” “I know his/her characteristics and how to deal with them”, and “I know what each person does” (p>0.7). An interview survey showed that “face-to-face relationships” consisted of “know the name and face” “know what s/he is like” and “trust in each other”. As effects of “face-to-face relationships” on community care networks, the following items were extracted: “It facilitates easy communication” “It provides me with information on who is responsible for which problem” “It facilitates smooth communication by changing my approach” “It makes me effective at work” “It gives me a sense of intimacy”, and “it gives me the responsibility”. Thus, preliminary findings of the concept and effects of “face-to-face relationships” were obtained.

Purpose: Improving knowledge of palliative care among cancer patients and the general public may be useful for achieving a better quality of life for cancer patients. The aim of this study was to identify the actual situation after the dissemination of leaflets, booklets, and posters as a part of a regional palliative care program. Methods: We distributed leaflets, booklets, and posters on palliative care to 257 administrative and health institutions across the region. We also visited 216 institutions (84%) to observe the actual situation and performed interviews in 133 of the institutions (62%). Results: Overall, 58% of the institutions used the leaflets, booklets or posters. Public halls, libraries and hospitals used them at a rate of 65% or higher. Interviews identified 7 themes, including "explaining the aim of the project before dissemination is important", "few cancer patients or even the general public visit", "staff made various efforts to display the items after dissemination", and "staff learned from the leaflets and booklets, even if cancer patients seldom visited". Conclusion: The dissemination of leaflets, booklets or posters throughout the region might be useful for conveying accurate knowledge about palliative care not only for cancer patients and the general public, but also for health care professionals. Target institutions should include public halls, libraries, and hospitals, and pre-dissemination discussions about the aim of the project and what kinds of people visit the institutions in addition to post-dissemination follow-up may be useful. Palliat Care Res 2010;5(2): 171-174

The primary aim of this study was to collect the views of physicians and nurses in the regions where community-based palliative care intervention trial, the OPTIM-study, was performed. A content analysis of free comments of the questionnaire survey was conducted. Questionnaires were mailed to 1,763 physicians and 3,156 nurses after the intervention, and 706 and 2,236 responses were obtained, respectively. A content analysis identified 327 free comments from physicians and 737 from nurses. As favorable effects, the categories [Multidisciplinary teams and community networks were established] [Home-based care is widespread] [Medical knowledge and skills are acquired just as those involved in palliative care] emerged. The main effects of the community palliative care program included the establishment of multidisciplinary teams and community networks, development of home-based care, and increasing knowledge, skills, and awareness about palliative care.

The purpose of the present study was to obtain the insights about the roles of specialized home care clinics and the “Doctor net” in community palliative care by investigating changes in the home death rates of cancer patients in a city where both specialized home care clinics and the Doctor net are available. A region palliative care intervention study was conducted, and data on the rate of cancer patients who died at home between 2007 and 2010 in the region were collected. The rate of cancer patients who died at home increased from 7.0% in 2007 to 13.0% in 2010. In 2007, 49% of the total number of people who died at home were patients of specialized home care clinics, and the rate increased to 13.0% in 2010. However, the number of cancer patients of other clinics who died at home did not decrease, from 63 in 2007 to 98 in 2009 and 77 in 2010. The functions of specialized home care clinics and the Doctor net adopted in general clinics were not exclusive to each other, and specialized home care clinics may improve palliative care implemented for cancer patients at home by participating in the Doctor net to provide general clinics with support.

The aim of this study is to collect the suggestions and recommendations of health care professionals involved in the regional palliative care program (OPTIM-study). A total of 101 multidisciplinary health care professionals who participated in the intervention program were interviewed, and 107 meaningful units were obtained from 89 valid interviews. The responses were categorized into “suggestions regardless of profession” (n=59), including “Participate in a multi-disciplinary conference to expand the network of people”, “Try to understand the situation of others”, “Seek support from others when you cannot solve the problem by yourself”, “Pursue all possibilities before giving up”, and “Do not try too hard”. As suggestions to those engaged in each profession, “Suggestions to community pharmacies” and “Suggestions to care managers” are frequently described. An examination of suggestions by the participants in the regional palliative care program could provide some insights to improve community palliative care.

The aim of the present study was to examine the current use of a palliative care manual, brochures for patients, and assessment tools designed for the regional intervention study. A questionnaire survey (706 physicians and 2,236 nurses) and interviews (80 health care professionals) were conducted. The tools health care professionals most frequently used were the manual and brochures for families of imminently dying patients. Health care professionals experienced [shared understanding as a region level despite the clinical experience and specialty] and [increased confidence in palliative care they had practiced without clear evidence]. The manual were positively evaluated because they “cover all necessary information”, “come in an easy-to-carry-around size”, and “provide specific and practical advice”. Health care professionals valued the brochures for families of imminently dying patients, because illustrations were very helpful as oral explanation was difficult. This study suggests that the manual and brochures for families of imminently dying patients could serve to improve region-based palliative care.

The primary aim of this study was to describe how patient-held-records was used in the regional palliative care program (OPTIM-study). The number of patient-held-records disseminated was 1,131 per region per year. A total of 15% and 16% of 706 physicians and 2,236 nurses in the region reported that they used patient-held-records disseminated during the study periods, respectively. In-depth interview identified themes [difficulty in dissemination], potential benefits of patient-held-records ([improved sense-of-control of patients], [improved information sharing among health care professionals]), and barriers ([lack of patient-perceived benefits and patient burden], [necessity that all health care professionals involved should be aware the value of patient-held-records and understand how to use it]). Of 11 hospitals who introduced patient-held-records, only 2 hospitals continued to use it during 3-year study periods. In conclusion, region-wide dissemination of patient-held-records seems to be unfeasible in many regions in Japan.

The purpose of this study was to identify the greatest impact of the regional palliative care program on community health care professionals. Interviews were conducted involving 101 people who became involved in the intervention program implemented in 4 areas across Japan, and 96 valid responses were collected. The following were cited as the greatest impact: [I developed a network of people, and realized the importance of collaboration] (n＝61; “I was able to develop an interpersonal relationship” and “Now I understand the significance of collaboration”), [My knowledge and skills regarding palliative care were improved] (n＝18; “Knowledge and support helped me respond to patients with confidence” and “I have come to think that there is more to palliative care than terminal care”), [I rediscovered my role through a wide variety of experiences] (n＝10), [Both collaboration and palliative knowledge/skills meant a lot to me] (n＝4), [What I experienced in this program will help me play my role] (n＝2), and [Patients and their families became satisfied] (n＝1). The community palliative care program was most effective in facilitating collaboration, and helped participants develop knowledge and skills concerning palliative care.